Primary Care Toolkit for Family Physicians
The College of Family Physicians of Canada
Learning and Complexity
An important strategic discussion is the level of complexity users will prefer in the electronic information system they are acquiring. The literature on this subject reveals distinct differences between the degree of functionality of a system and its likelihood of full implementation based on the degree of complexity in learning about and using the system.
The complexity of technology adoption might be considered as follows:
- Level 1
- Physician's personal use of a computer is rarely if ever used at the point of care. Billing systems and other software are in use in the office. Electronic resources are not used on a regular basis to look up clinical information.
- Level 2
- The practice is primarily paper-based. However, care delivery is assisted with some electronic resources such as online access to clinical practice guidelines and/or PDA use for looking up medical information. The family physician and the office staff may use email. The internet and other tools are not used for direct management of patient information and care.
- Level 3
- The practice is becoming a hybrid, using paper-based and electronic information. The physician uses IT tools to manage focused elements of practice, promoting clinical quality improvement. The practice is supported by tools that aid in the direct management of patient care, e.g. decision support tools to help care for diabetic patients.
- Level 4
- The physician and the practice are EMR-based for the vast majority of all patient care. The practice uses tools that support new workflows and change management to deliver high quality, pro-active care based on clinical evidence and practice guidelines.
It is essential that groups carefully analyze both the knowledge and learning aptitude of their members before deciding whether to purchase an easily learned but relatively unsophisticated system, as opposed to a highly sophisticated, more difficult system that may, in time, provide better functionality. In addition, it is important to factor in time for staff training, learning and updates as new electronic information systems are introduced or changed. Data entry models should remain flexible for family physicians and other staff in the practice or group to accommodate the time required to enter data and to learn more about the system.
It is recommended that family physicians embarking on major information technology changes within their office or group practice, invest in change management resources. These might include hiring a medical information technology change management expert (not just an information technology expert) to facilitate change and to manage the various challenges first encountered when new electronic systems and programs are incorporated into clinical practice.
Many family physicians find, in the early stages of implementation, that their capacity for patient throughput is diminished as they embark on their own learning curves. This is an expectation that should be considered. It is important that physician bookings reflect the need for incremental time during the early phases of electronic information system implementation.